Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Curr Opin Pulm Med. 2018 Jul;24(4):384-391. doi: 10.1097/MCP.0000000000000490.
Pleural effusions in patients with hematologic malignancy may represent malignant pleural effusion (MPE) or occur secondary to infection, treatment effects, and other common causes. The impact of MPE on prognosis in this cohort remains unclear. Indwelling pleural catheters (IPCs) are routinely placed for palliation of recurrent symptomatic MPEs, but perceived concerns over infection and bleeding may limit their use in patients with hematologic malignancies. However, recent evidence suggests IPCs are both well tolerated and effective in this cohort. In this review, the evaluation of pleural effusions in hematologic malignancies and their management with an IPC are outlined.
Two retrospective studies have been published regarding the use of IPCs in hematologic malignancies. Lymphomatous effusions are the most common cause of MPE in this cohort. The rates of complications and pleurodesis with IPC in hematologic malignancies are similar to those with solid organ tumors.
Pleural effusions in patients with hematologic malignancies may be managed safely with an IPC. Sterile technique, barrier protection, standardized algorithms for placement and removal, and quality assurance initiatives are crucial to centers that place IPCs for all patients. The safety of IPC in hematologic malignancies warrants a paradigm shift in the management of pleural disease for this cohort.
恶性血液病患者胸腔积液可能代表恶性胸腔积液（MPE），也可能继发于感染、治疗作用和其他常见原因。MPE 对该队列患者预后的影响尚不清楚。留置胸腔导管（IPC）通常用于缓解复发性有症状的 MPE，但对感染和出血的担忧可能会限制其在恶性血液病患者中的应用。然而，最近的证据表明，IPC 在该队列中耐受性良好且有效。在这篇综述中，概述了恶性血液病患者胸腔积液的评估及其 IPC 管理。
已有两项关于恶性血液病中 IPC 使用的回顾性研究发表。淋巴瘤性渗出是该队列中 MPE 的最常见原因。恶性血液病患者中 IPC 并发症和胸膜固定术的发生率与实体器官肿瘤相似。
恶性血液病患者的胸腔积液可以通过 IPC 安全管理。无菌技术、屏障保护、放置和移除的标准化算法以及质量保证计划对于为所有患者放置 IPC 的中心至关重要。IPC 在恶性血液病中的安全性需要改变该队列胸腔疾病管理的范式。
